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quality of life cancer
Index
Sr. no                     Content             Page no.

  1      Introduction to cancer                  1

  2      Causes of cancer                        1

  3      Treatment of cancer                     2

  4      Quality of life                         3

  5      Impact of cancer on quality of life     3

  6      Physical aspects                       4-11

  7      Psychological aspects                 12-15

  8      Social aspects                          16

  9      Spiritual aspects                       17

 10      Conclusion                              18

 11      Key points                              19

 12      Assignment                              19
Introduction

        Human body is composed of many
millions of tiny cells, each a self-contained living
unit. Normal cells in the body grow and divide
for a period of time and then stop growing and
dividing. Cancer occurs when this cellular
reproduction process goes out of control. In
other words, cancer is a disease that is
characterized by uncontrolled, uncoordinated
and undesirable cell division.

   Cancer
       Cancer is a disease characterized abnormal and
uncontrolled growth of cancer cells.

   Causes of cancer

 Ø Cancers are primarily an environmental disease with 90-95% of
cases due to lifestyle and environmental factors and 5-10% due to
genetics.
 Ø Tobacco use. Cigarette smoking and regular exposure to
tobacco smoke greatly increase lung cancer.
 Ø Obesity. High-fat, high cholesterol diets are proven risk factors
for several types of cancer
 Ø Ionizing radiation. Radiation comes from radioactive fallout,
radon gas, x-rays, and other sources can cause cell damage that
leads to cancer.
 Ø Sexually transmitted HPV-infection. HPV increases your risk
factor for cervical, anal, vulvar and vaginal cancer.



                                                                       01
Ø Exposure to harmful chemicals (carcinogens). People who
     have certain jobs (such as painters, construction workers, and those in
     the chemical industry) have an increased risk of cancer.
      Ø Heredity. Some gene changes that increase the risk of cancer are
     passed from parent to child.

        Treatment of cancer

      Ø At present, there exists a variety of
       acceptable treatments for cancer.
      Ø Surgery. It is effective in removing
       cancer that is limited to an organ or
       area of the body. Surgery is
       performed for treatment of cancer,
       p a l l i a t i o n , p a i n c o n t ro l a n d        Surgery
       diagnosis.

      Ø Chemotherapy. Cancer drugs can kill or
       stop the growth of your tumor, as well as
       cancer cells that may have spread from the
       original tumor site.

      Ø Radiation therapy. It is the use of high-
       energy rays to kill cancer cells. It may be used
       alone to try to cure the cancer or to reduce
                                                            Chemotherapy
       some of the discomfort created by your
       tumor.

      Ø Hormone therapy. Hormones can
       make tumour grow




                                                          Radiation therapy

02
Quality of life

   Ø Under normal circumstances,
most of us would probably define
quality of life as companionship with
family and friends, rewarding work,
the knowledge that we make a
difference in the lives of others, the
freedom to pursue a multitude of
interests, the joy of learning
something new. The list is as varied
as we are.
   Ø Under the abnormal circumstance of receiving a cancer
diagnosis and undergoing treatment, these sources of satisfaction and
self-esteem can be severely compromised. Quality of life diminishes

   Impact of cancer on quality of life

  Ø Cancer affects the quality of life (QOL) of individuals with the
disease and also that of their family members and close friends. This is
significant throughout the trajectory of the illness. Patients progress
through different phases and experience different reactions after
being given the diagnosis of cancer.
  Ø The initial phase is the pre treatment phase, the symptoms
experienced by the patients include anxiety, fatigue, and pain.
  Ø The second phase is the primary treatment phase, during this
time patient's experience, in addition to the above mentioned
symptoms, other disease-specific symptoms.
  Ø The third Phase is the post treatment phase. In this phase,
patients often experience treatment-related symptoms. Decreased
movement, loss of strength, anxiety, and depression...
  Ø The fourth phase is the recurrence phase. Shock, disbelief,
anxiety, fear, grief, and a feeling of betrayal and anger are common in
this phase along with loss of appetite and depression.
  Ø The fifth and final phase is the end-of-life phase. During this
phase there may be a feeling of alienation or isolation. Fear of
impending death and concern over the events preceding death.             03
Aspects of quality of life

       Ø In general the quality of life can be categorized into following
     aspects.
        – Physical aspect
        – Psychological aspect
        – Social aspect
        – Spiritual aspect




          Physical Aspect

       Ø Physical aspect involves a variety of aspects that support
     physical well-being.
       Ø Physical health is important to your overall well being true to
     the old proverb “A sound mind in a sound body.”
       Ø By maintaining good physical health during your course of
     cancer treatment helps you better cope with your treatment, boost
     your immune system, better nourished and experience improved
     quality of life.

04
Pain

  Ø Cancer pain is a subjective sensation of tissue damage, which
has an adverse influence on multiple domains in an individual's life.
  Ø Severe pain is associated with decreased function, increased
interference with daily activities, depression, and anxiety.

Causes of Cancer Pain:
Ø People with cancer can experience
pain from different sources: the tumor
itself can cause pain the treatment too
can cause pain.
   Ø Pain needs to be assessed to treat
properly it can be done with the help of
pain scale.                                          Pain




Pain management methods
  F Hot and cold packs, to relieve painful areas of the body.
  F Massage and physical therapy.
  F Hypnosis and diversional therapy.
  F Stretching and range-of-motion exercises, to maintain
    strength, flexibility, and mobility.
  F Acupuncture is a traditional Chinese medicine, which involves
    inserting very tiny needles into the body.




                                                                        05
F Transcutaneous electric nerve stimulation (TENS). This
    uses a mild electrical current from a power pack to relieve pain.
      F Progressive muscle relaxation (PMR). It is based upon the
    simple practice tightening one muscle group at a time followed by a
    relaxation phase with release of the tension.
      F Guided imagery. It is a technique in which patients use their
    imagination to visualize improved health.

       Fatigue

      Ø Fatigue is a feeling of tiredness or not having enough energy after
    rest or a good sleep that can have a negative impact on quality of life.
      Ø Fatigue is most common, as well as one of the most debilitating,
    side effects experienced by cancer patients.
      Ø Fatigue is also a frequent side effect of surgery, radiation,
    chemotherapy, or immunotherapy.
      Ø Common signs of fatigue include:
        ™ Feeling tired even after a good night's sleep
        ™ Feeling sleepy throughout the day
        ™ Feeling too weak to stand
        ™ Finding it difficult to start routine
              activities
        ™ Needing to stop in the middle of
              activities to rest
        ™ Not being able to do activities for
              long
        ™ Difficulty in concentrating
        ™ Irritability                                      Fatigue

   How to be free from fatigue?
     F Eat a balanced diet. A more nutritious diet may increase your
         energy level.
     F Delegate activities that someone can do for you.
     F Sit if you need to when doing tasks.
     F Rest in bed on a very bad day. But, lift your legs, circle your
         ankles, and stretch your arms and legs every 2 hours.
06   F Use assistive devices to help you reach. But stretch and reach
         unassisted whenever you can.
F Remember that exercise and moving are ways to lessen fatigue,
       the more you move the better you will feel overall.
  F Sleep when you are tired. But don't stay in bed all day. Try to get
      up and walk a few steps or more.




  Sleep disorder

  Ø Sleep disorders such as
insomnia, multiple awakenings and
early waking can be attributed to
many side effects of cancer or its
treatments. These include depression,
anxiety, stress, pain, and medication
side effects.
  Ø Lack of sleep can undermine
your healing process and your ability
to function.
 Sleep disorders can be reduced by following methods
   F Go to bed and get up at about the same time every day, even on
        the weekends.
   F Don't eat or drink large amounts before bedtime.
   F Avoid nicotine, caffeine and alcohol in the evening.
   F Exercise regularly.
   F Make your bedroom cool, dark,
        quiet and comfortable.
   F Sleep primarily at night avoid
        daytime naps.
   F Choose a comfortable mattress and
        pillow.
   F Make sure you have a bed that's
        comfortable.                                                07
   F Go to bed when you're tired and turn out the lights.
Nutrition

       Ø Nausea, loss of appetite and changes in taste perception are
     common side effects of cancer and its treatment. These symptoms can
     reduce your enjoyment of food, and may result in decreased nutrition.
       Ø Diarrhea and constipation also negatively affect your ability to
     obtain adequate nutrition.
       Ø Good nutrition is an essential part of cancer treatment. A well-
     balanced diet also prevents the breakdown of body tissue, helps
     rebuild the tissue that cancer may harm, and helps maintain the body's
     immune system.




                                  Balanced diet

     Healthy eating tips in cancer
       F Eat smaller meals more frequently.
       F Keep fat levels low. Fat contains a high amount of calories.
       F Increasing protein. Protein is important for growth, health
            and repair of your body.
       F Increasing calories. During illness, treatment or recovery, your
            need for calories may be greater than usual.
       F Eat all types of fruits and vegetables a day.
       F Drink lots of water.
08     F Multivitamin tablets.
Foods to avoid in cancer
  û Foods containing acrylamide, such as french
      fries and potato chips.
  û   Trans fats.
  û   Soda.
  û   Processed meats.
  û   Fried foods.
  û   Foods containing the preservatives BHT, BHA.
  û   Smoked and pickled foods.

  Exercise

  Ø Many patients find that their level of physical activity diminishes
due to their disease, its treatment, or some combination of both.
This is particularly true for patients who are hospitalized or
bedridden. It can also be an issue for all patients suffering from pain,
lethargy, or depression.
  Ø One of the best ways to combat these symptoms is to exercise. No
matter how seemingly insignificant, move your body!




  Ø With the help of exercise you will be tolerate the side effects of
chemotherapy, radiation, and surgery in a better manner.
  Ø Cancer, as well as cancer treatments can increase the risk of blood
clots, exercise will help to prevent clot formation.
  Ø Weight-bearing exercises, such as walking and resistive exercises
using weights, help keep your bones strong and healthy and will help to
prevent osteoporosis which is a side effect of steroid therapy
                                                                           09
Exercise for people living with cancer
       Ø Warm-up. It is important to warm-up at the start of each
     exercise session.
       Ø Warming up helps to get you going and reduces your chance of
     injury.
       Ø A warm-up should include 5-10 minutes of some light
     stretching activities.
      These are some of the exercise that can be done.




             Push ups                              Calf raise




              Chair raise                           Squat




10            Shoulder press                     Shoulder press
Biceps curl                          Triceps extension


  Sexuality

  Ø Sexual problems may be the result of a
physical problem related to either the cancer
itself or its treatment. A decline in erectile
function, common in men with prostate cancer,
can be treated with external penile vacuum
devices, injections, prosthetic penile implants
or prescription medication such as Viagra.
  Ø In women, problems include increased or
decreased vaginal discharge caused by chemo-
hormonal therapy drugs or a narrowing of the
vagina due to radiation of the pelvis. Such
conditions can be treated using medical creams, lubricants,
hormone replacement therapy, or vaginal dilations.
  ØIf you are experiencing emotional or physical problems with your
sexuality, you can take charge by discussing them with your partner
and/or consulting your physician or a sex therapist.




                                                                      11
Psychological Aspect
       Ø A diagnosis of cancer often brings up one of people’s worst
     health fears. It affects the complete psychological status of the
     patient.
       Ø Psychological aspects includes the different aspects related to
     the mental status of the patient. Following are the psychological
     aspects of quality of life in cancer.

        Cognitive functioning

       Ø Cancer patients undergoing chemotherapy
     or brain radiation experience increased
     forgetfulness, a decreased attention span and
     problems concentrating.
       Ø In most cases, cognitive dysfunction is
     minimal and limited to simple forgetfulness or
     loss of coordination.
       Ø Mental exercises such as doing mind
     games, crossword puzzles, playing chess
     or other games of strategy can keep the mind
     sharp and focused.

        Stress

      Ø Stress is an inherent component of a
     cancer diagnosis for both the patient and the
     family and friends. The mind's natural
     tendency is to run off in an infinite number of
     directions, each with its own stress and fear.
       Ø Stress reduction techniques, such as self-
     hypnosis, yoga, biofeedback, meditation,
     and acupuncture, acupressure, healing
     massage, or keeping a journal cultivate inner
     peace and may even benefit to reduce your
     stress.
12
Anxiety

  Ø Anxiety is a normal reaction to cancer.
Anxiety associated with cancer may
increase feelings of pain, interfere with
one's ability to sleep, cause nausea and
vomiting, and interfere with the patient's
quality of life.

 Tips to reduce anxiety
 F Whenever possible, lower your risk (for example, avoid
       alcohol to relieve symptoms).
 F Find a technique that works for you to lower your anxiety & use
       it (like slow deep breathing, in & out, 15 times).
 F Follow your treatment plan & take your medications exactly
   as prescribed.
 F Take guidance from doctor or a counselor.
 F Keep a diary or journal of how you are feeling once treatment
   is started. Let your health care professional know if your
   symptoms are getting better or worse.

   Depression

   Ø Depression is a disabling illness that affects of cancer patients.
It affects men and women with cancer equally.
   Ø People who face a diagnosis of cancer will experience different
levels of stress and emotional upset.

 Issues in the life causing anxiety in cancer may are
   ™    Fear of death.
   ™    Interruption of life plans.
   ™    Changes in body image and self-esteem.
   ™    Changes in social role and lifestyle.
   ™    Money and legal concerns.

                                                                          13
Positive thinking

      Ø A positive and optimistic outlook
     will not only improve your quality of life
     but also improve your chances of getting
     well.
        Ø When you have cancer, it can be
     difficult to maintain a positive attitude.
     Daily you are confronted with many
     obstacles, including the side effects of the
     illness and treatment.
        Ø One way you can help yourself maintain a positive attitude is by
     setting reasonable, achievable goals. Another helpful hint is to put
     your energy into activities that bring satisfaction to your life.


        Hope

       Ø Hope is a force that sustains and regenerates your will to live.
     Even if there is only a remote chance for a successful outcome, hope
     can still empower the spirit to fight for life.
       Ø Hope can be nourished in many ways,
     including accomplishing a goal, having
     control over your life, feeling appreciated and
     useful, experiencing religious faith, and
     spending quality time with family and
     friends.
       Ø Recent advances in cancer therapy are
     also a cause for hope. There are over two
     hundred new drugs, vaccines, and antigrowth
     factors currently being tested in clinical
     research. Because of these and other
     advances in cancer research, it is wise not to focus on the statistics
     concerning your illness. Statistics can give you a general idea of the
     odds for getting better or having a recurrence of disease, but they only
     represent averages. You are not 40 percent of anything!
14
Coping

   Ø Coping refers to the attitudes you
develop and the actions you take to maintain
your equilibrium and adjust to the stresses
caused by cancer.
   Ø Different people cope in different ways.
It is normal to feel frustrated at times, but how
you cope, and your attitude can make a
difference. By externalizing your frustrations,
you can improve your quality of life.


 Some ways of coping that you may find helpful are:
 F Relying on others for support and assistance.
 F Sharing your feelings with others.
 F Seeking professional counseling.
 F Setting realistic goals and readjusting them when necessary
 F Controlling fear and anxiety with stress reduction techniques
 F Adopting a mantra, or a reassuring phrase
 F Giving yourself time to adjust to and recover from bad news
 F Accepting your limitations
 F Recognizing that you still have control
   over many aspects of your life
 F Moving on from mistakes rather than
   letting them debilitate or destroy you
 F Alleviating day-to-day stress




                                                                   15
Social Aspect
        Ø The society where a person live plays a important role in shaping
     the person's perception about the life.
        Ø Socializing allows you to share your ideas, believes, values and
     provides an equal opportunity to listen to what others have to say and
     have a positive attitude towards problems you may face in everyday
     life.

        Family/Friends

       Ø The support of family and friends is an essential part of
     maintaining your quality of life.
       Ø Family and friends provide you with
     emotional support, physical comfort,
     spiritual guidance, a welcome diversion and
     assistance.
       Ø Spending quality time with your friends
     and family will enrich your life. Share a meal,
     play a game, or look through an old photograph
     album together.
       Ø Writing an ethical will - or your
     philosophy of life - is another way to share
     important beliefs with your family.

        Support group

       Ø Support groups provide patients with an
     opportunity to see the problems they are
     confronting through the eyes of others. This can
     give patients a new perspective on their situation,
     reduce the inappropriate guilt felt by some, and
     help patients to recognize that their problems are
     the result of the cancer, rather than some personal
     failing. Questions such as "Why me?" take on a
     new meaning in a group of people wondering the same thing.
16
Spiritual Aspect
  Ø Being spiritual helps in more than one way. It is good to keep
your faith on supreme being whom you trust.
  Ø Trust on spiritual being channels your energy to your creator. No
matter what is your religion, faith in your creator can bring you peace,
good health and all other blessing.
   Spirituality, Faith and Religion
  Ø At times of extreme vulnerability, we all tend to pay more
attention to our innate spirituality and seek to restore a feeling of
being connected with the universe or a spiritual idea beyond
ourselves.
  Ø We may seek this liaison through
prayer and a renewed devotion to
God. In the event of treatment failure
and progressive disease, spirituality
can help ease the pain of separation
from loved ones and the things of this
world.
  Ø Spirituality also plays a role in
end-of-life care, helping patients
utilize their remaining time to achieve
a sense of peace and purpose, even in
their final weeks, days or hours. Spiritual practices can strengthen
feelings of hope or give meaning to life prior to death
  Some religion's way to increase one's feeling of being in control
  ™ Collaborative religious coping- Seeking control in solving
problems through a partnership with God.
  ™ Active religious surrender- Turning control over to God after
all else has failed.
  ™ Pleading for direct intercession- Seeking control indirectly
by praying for a miracle or divine intercession
  ™ Passive religious deferral- Waiting for God to control the
situation
  ™ Self-directing religious coping- Believing that God gives 17
individuals the tools and resources to solve problems
Leaving instructions to loved ones

       Ø Therefore, this is the time to leave clear instructions as to
     whether you want to be resuscitated or treated, if you have no chance
     of regaining a reasonable quality of life.
       Ø You will also want to leave written
     instructions for your family and friends,
     if death occurs, telling them how you
     want your remains handled and type of
     funeral service.
       Ø If you don't have a will for the
     disposition of your estate, this is a good
     time to get that out of the way as well.
     You can always change it later. The act of leaving instructions on these
     matters is a gift to those you love.



        Conclusion

        Ø Health professionals today believe that a combination of medical
     therapy and supportive care offers the best chance to maintain a
     patient's quality of life.
        Ø Satisfaction of these diverse needs demonstrates the powerful
     connection between mind and body and improves quality of life.
        Ø Cancer - because it can have an impact on every aspect of your
     life, from your faith and the quality of your relationships to your
     physical being and your career is an assault on your life. Yet, as we have
     seen with so many of our patients, it need not destroy the quality of
     your life.




18
Steps for Improving Your Quality of Life

 F Conserve your energy for essential or pleasurable activities.
 F Work collaboratively with your medical team so that you can get
      the best possible medical and supportive care.
 F    Set realistic, achievable goals.
 F    Don't let mistakes debilitate or destroy you. Move on.
 F    Avoid negative thinking and self-destructive behavior.
 F    Make end-of-life decisions, including writing legal and medical
      wills, and an Advanced Directive.
 F    Take control. Even when your prognosis is not good, you still
      have choices.
 F    Try to maintain your hope, endurance, faith, and courage.
      Seek spiritual guidance from your faith, community, religious
      or inspirational readings, or other sources.
 F    Acknowledge your need for psychological support and seek
      assistance from a professional counselor, pastor, social worker,
      or a wise friend or family member.
 F    Learn new techniques to promote relaxation, such as yoga and
      meditation.
 F    Engage in pleasurable diversions, such as art, music, hobbies,
      social events and physical activities.
 F    Give of yourself to others.
 F    Strengthen your relationships by spending more quality time
      with family members and friends.
 F    Recognize the sources of your anger and use techniques of
      forgiveness and mindful meditation to move on.
 F    Try not to let your illness dominate your life. Be willing to make
      the necessary compromises as you go through treatment.
   Assignment

1. Cancer is the abnormal and uncontrolled __________ of cancer cells.
2. Surgery removes___________tissues from the body.
3. _________is the use of high-engergy rays to kill cancer cells.
4. Cancer diagnosis and treatment diminishes the_________ of life.
5.Quality of life can be categorized into_______,_______,_______&______ aspects
                                                                                  19

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quality of life cancer

  • 2. Index Sr. no Content Page no. 1 Introduction to cancer 1 2 Causes of cancer 1 3 Treatment of cancer 2 4 Quality of life 3 5 Impact of cancer on quality of life 3 6 Physical aspects 4-11 7 Psychological aspects 12-15 8 Social aspects 16 9 Spiritual aspects 17 10 Conclusion 18 11 Key points 19 12 Assignment 19
  • 3. Introduction Human body is composed of many millions of tiny cells, each a self-contained living unit. Normal cells in the body grow and divide for a period of time and then stop growing and dividing. Cancer occurs when this cellular reproduction process goes out of control. In other words, cancer is a disease that is characterized by uncontrolled, uncoordinated and undesirable cell division. Cancer Cancer is a disease characterized abnormal and uncontrolled growth of cancer cells. Causes of cancer Ø Cancers are primarily an environmental disease with 90-95% of cases due to lifestyle and environmental factors and 5-10% due to genetics. Ø Tobacco use. Cigarette smoking and regular exposure to tobacco smoke greatly increase lung cancer. Ø Obesity. High-fat, high cholesterol diets are proven risk factors for several types of cancer Ø Ionizing radiation. Radiation comes from radioactive fallout, radon gas, x-rays, and other sources can cause cell damage that leads to cancer. Ø Sexually transmitted HPV-infection. HPV increases your risk factor for cervical, anal, vulvar and vaginal cancer. 01
  • 4. Ø Exposure to harmful chemicals (carcinogens). People who have certain jobs (such as painters, construction workers, and those in the chemical industry) have an increased risk of cancer. Ø Heredity. Some gene changes that increase the risk of cancer are passed from parent to child. Treatment of cancer Ø At present, there exists a variety of acceptable treatments for cancer. Ø Surgery. It is effective in removing cancer that is limited to an organ or area of the body. Surgery is performed for treatment of cancer, p a l l i a t i o n , p a i n c o n t ro l a n d Surgery diagnosis. Ø Chemotherapy. Cancer drugs can kill or stop the growth of your tumor, as well as cancer cells that may have spread from the original tumor site. Ø Radiation therapy. It is the use of high- energy rays to kill cancer cells. It may be used alone to try to cure the cancer or to reduce Chemotherapy some of the discomfort created by your tumor. Ø Hormone therapy. Hormones can make tumour grow Radiation therapy 02
  • 5. Quality of life Ø Under normal circumstances, most of us would probably define quality of life as companionship with family and friends, rewarding work, the knowledge that we make a difference in the lives of others, the freedom to pursue a multitude of interests, the joy of learning something new. The list is as varied as we are. Ø Under the abnormal circumstance of receiving a cancer diagnosis and undergoing treatment, these sources of satisfaction and self-esteem can be severely compromised. Quality of life diminishes Impact of cancer on quality of life Ø Cancer affects the quality of life (QOL) of individuals with the disease and also that of their family members and close friends. This is significant throughout the trajectory of the illness. Patients progress through different phases and experience different reactions after being given the diagnosis of cancer. Ø The initial phase is the pre treatment phase, the symptoms experienced by the patients include anxiety, fatigue, and pain. Ø The second phase is the primary treatment phase, during this time patient's experience, in addition to the above mentioned symptoms, other disease-specific symptoms. Ø The third Phase is the post treatment phase. In this phase, patients often experience treatment-related symptoms. Decreased movement, loss of strength, anxiety, and depression... Ø The fourth phase is the recurrence phase. Shock, disbelief, anxiety, fear, grief, and a feeling of betrayal and anger are common in this phase along with loss of appetite and depression. Ø The fifth and final phase is the end-of-life phase. During this phase there may be a feeling of alienation or isolation. Fear of impending death and concern over the events preceding death. 03
  • 6. Aspects of quality of life Ø In general the quality of life can be categorized into following aspects. – Physical aspect – Psychological aspect – Social aspect – Spiritual aspect Physical Aspect Ø Physical aspect involves a variety of aspects that support physical well-being. Ø Physical health is important to your overall well being true to the old proverb “A sound mind in a sound body.” Ø By maintaining good physical health during your course of cancer treatment helps you better cope with your treatment, boost your immune system, better nourished and experience improved quality of life. 04
  • 7. Pain Ø Cancer pain is a subjective sensation of tissue damage, which has an adverse influence on multiple domains in an individual's life. Ø Severe pain is associated with decreased function, increased interference with daily activities, depression, and anxiety. Causes of Cancer Pain: Ø People with cancer can experience pain from different sources: the tumor itself can cause pain the treatment too can cause pain. Ø Pain needs to be assessed to treat properly it can be done with the help of pain scale. Pain Pain management methods F Hot and cold packs, to relieve painful areas of the body. F Massage and physical therapy. F Hypnosis and diversional therapy. F Stretching and range-of-motion exercises, to maintain strength, flexibility, and mobility. F Acupuncture is a traditional Chinese medicine, which involves inserting very tiny needles into the body. 05
  • 8. F Transcutaneous electric nerve stimulation (TENS). This uses a mild electrical current from a power pack to relieve pain. F Progressive muscle relaxation (PMR). It is based upon the simple practice tightening one muscle group at a time followed by a relaxation phase with release of the tension. F Guided imagery. It is a technique in which patients use their imagination to visualize improved health. Fatigue Ø Fatigue is a feeling of tiredness or not having enough energy after rest or a good sleep that can have a negative impact on quality of life. Ø Fatigue is most common, as well as one of the most debilitating, side effects experienced by cancer patients. Ø Fatigue is also a frequent side effect of surgery, radiation, chemotherapy, or immunotherapy. Ø Common signs of fatigue include: ™ Feeling tired even after a good night's sleep ™ Feeling sleepy throughout the day ™ Feeling too weak to stand ™ Finding it difficult to start routine activities ™ Needing to stop in the middle of activities to rest ™ Not being able to do activities for long ™ Difficulty in concentrating ™ Irritability Fatigue How to be free from fatigue? F Eat a balanced diet. A more nutritious diet may increase your energy level. F Delegate activities that someone can do for you. F Sit if you need to when doing tasks. F Rest in bed on a very bad day. But, lift your legs, circle your ankles, and stretch your arms and legs every 2 hours. 06 F Use assistive devices to help you reach. But stretch and reach unassisted whenever you can.
  • 9. F Remember that exercise and moving are ways to lessen fatigue, the more you move the better you will feel overall. F Sleep when you are tired. But don't stay in bed all day. Try to get up and walk a few steps or more. Sleep disorder Ø Sleep disorders such as insomnia, multiple awakenings and early waking can be attributed to many side effects of cancer or its treatments. These include depression, anxiety, stress, pain, and medication side effects. Ø Lack of sleep can undermine your healing process and your ability to function. Sleep disorders can be reduced by following methods F Go to bed and get up at about the same time every day, even on the weekends. F Don't eat or drink large amounts before bedtime. F Avoid nicotine, caffeine and alcohol in the evening. F Exercise regularly. F Make your bedroom cool, dark, quiet and comfortable. F Sleep primarily at night avoid daytime naps. F Choose a comfortable mattress and pillow. F Make sure you have a bed that's comfortable. 07 F Go to bed when you're tired and turn out the lights.
  • 10. Nutrition Ø Nausea, loss of appetite and changes in taste perception are common side effects of cancer and its treatment. These symptoms can reduce your enjoyment of food, and may result in decreased nutrition. Ø Diarrhea and constipation also negatively affect your ability to obtain adequate nutrition. Ø Good nutrition is an essential part of cancer treatment. A well- balanced diet also prevents the breakdown of body tissue, helps rebuild the tissue that cancer may harm, and helps maintain the body's immune system. Balanced diet Healthy eating tips in cancer F Eat smaller meals more frequently. F Keep fat levels low. Fat contains a high amount of calories. F Increasing protein. Protein is important for growth, health and repair of your body. F Increasing calories. During illness, treatment or recovery, your need for calories may be greater than usual. F Eat all types of fruits and vegetables a day. F Drink lots of water. 08 F Multivitamin tablets.
  • 11. Foods to avoid in cancer û Foods containing acrylamide, such as french fries and potato chips. û Trans fats. û Soda. û Processed meats. û Fried foods. û Foods containing the preservatives BHT, BHA. û Smoked and pickled foods. Exercise Ø Many patients find that their level of physical activity diminishes due to their disease, its treatment, or some combination of both. This is particularly true for patients who are hospitalized or bedridden. It can also be an issue for all patients suffering from pain, lethargy, or depression. Ø One of the best ways to combat these symptoms is to exercise. No matter how seemingly insignificant, move your body! Ø With the help of exercise you will be tolerate the side effects of chemotherapy, radiation, and surgery in a better manner. Ø Cancer, as well as cancer treatments can increase the risk of blood clots, exercise will help to prevent clot formation. Ø Weight-bearing exercises, such as walking and resistive exercises using weights, help keep your bones strong and healthy and will help to prevent osteoporosis which is a side effect of steroid therapy 09
  • 12. Exercise for people living with cancer Ø Warm-up. It is important to warm-up at the start of each exercise session. Ø Warming up helps to get you going and reduces your chance of injury. Ø A warm-up should include 5-10 minutes of some light stretching activities. These are some of the exercise that can be done. Push ups Calf raise Chair raise Squat 10 Shoulder press Shoulder press
  • 13. Biceps curl Triceps extension Sexuality Ø Sexual problems may be the result of a physical problem related to either the cancer itself or its treatment. A decline in erectile function, common in men with prostate cancer, can be treated with external penile vacuum devices, injections, prosthetic penile implants or prescription medication such as Viagra. Ø In women, problems include increased or decreased vaginal discharge caused by chemo- hormonal therapy drugs or a narrowing of the vagina due to radiation of the pelvis. Such conditions can be treated using medical creams, lubricants, hormone replacement therapy, or vaginal dilations. ØIf you are experiencing emotional or physical problems with your sexuality, you can take charge by discussing them with your partner and/or consulting your physician or a sex therapist. 11
  • 14. Psychological Aspect Ø A diagnosis of cancer often brings up one of people’s worst health fears. It affects the complete psychological status of the patient. Ø Psychological aspects includes the different aspects related to the mental status of the patient. Following are the psychological aspects of quality of life in cancer. Cognitive functioning Ø Cancer patients undergoing chemotherapy or brain radiation experience increased forgetfulness, a decreased attention span and problems concentrating. Ø In most cases, cognitive dysfunction is minimal and limited to simple forgetfulness or loss of coordination. Ø Mental exercises such as doing mind games, crossword puzzles, playing chess or other games of strategy can keep the mind sharp and focused. Stress Ø Stress is an inherent component of a cancer diagnosis for both the patient and the family and friends. The mind's natural tendency is to run off in an infinite number of directions, each with its own stress and fear. Ø Stress reduction techniques, such as self- hypnosis, yoga, biofeedback, meditation, and acupuncture, acupressure, healing massage, or keeping a journal cultivate inner peace and may even benefit to reduce your stress. 12
  • 15. Anxiety Ø Anxiety is a normal reaction to cancer. Anxiety associated with cancer may increase feelings of pain, interfere with one's ability to sleep, cause nausea and vomiting, and interfere with the patient's quality of life. Tips to reduce anxiety F Whenever possible, lower your risk (for example, avoid alcohol to relieve symptoms). F Find a technique that works for you to lower your anxiety & use it (like slow deep breathing, in & out, 15 times). F Follow your treatment plan & take your medications exactly as prescribed. F Take guidance from doctor or a counselor. F Keep a diary or journal of how you are feeling once treatment is started. Let your health care professional know if your symptoms are getting better or worse. Depression Ø Depression is a disabling illness that affects of cancer patients. It affects men and women with cancer equally. Ø People who face a diagnosis of cancer will experience different levels of stress and emotional upset. Issues in the life causing anxiety in cancer may are ™ Fear of death. ™ Interruption of life plans. ™ Changes in body image and self-esteem. ™ Changes in social role and lifestyle. ™ Money and legal concerns. 13
  • 16. Positive thinking Ø A positive and optimistic outlook will not only improve your quality of life but also improve your chances of getting well. Ø When you have cancer, it can be difficult to maintain a positive attitude. Daily you are confronted with many obstacles, including the side effects of the illness and treatment. Ø One way you can help yourself maintain a positive attitude is by setting reasonable, achievable goals. Another helpful hint is to put your energy into activities that bring satisfaction to your life. Hope Ø Hope is a force that sustains and regenerates your will to live. Even if there is only a remote chance for a successful outcome, hope can still empower the spirit to fight for life. Ø Hope can be nourished in many ways, including accomplishing a goal, having control over your life, feeling appreciated and useful, experiencing religious faith, and spending quality time with family and friends. Ø Recent advances in cancer therapy are also a cause for hope. There are over two hundred new drugs, vaccines, and antigrowth factors currently being tested in clinical research. Because of these and other advances in cancer research, it is wise not to focus on the statistics concerning your illness. Statistics can give you a general idea of the odds for getting better or having a recurrence of disease, but they only represent averages. You are not 40 percent of anything! 14
  • 17. Coping Ø Coping refers to the attitudes you develop and the actions you take to maintain your equilibrium and adjust to the stresses caused by cancer. Ø Different people cope in different ways. It is normal to feel frustrated at times, but how you cope, and your attitude can make a difference. By externalizing your frustrations, you can improve your quality of life. Some ways of coping that you may find helpful are: F Relying on others for support and assistance. F Sharing your feelings with others. F Seeking professional counseling. F Setting realistic goals and readjusting them when necessary F Controlling fear and anxiety with stress reduction techniques F Adopting a mantra, or a reassuring phrase F Giving yourself time to adjust to and recover from bad news F Accepting your limitations F Recognizing that you still have control over many aspects of your life F Moving on from mistakes rather than letting them debilitate or destroy you F Alleviating day-to-day stress 15
  • 18. Social Aspect Ø The society where a person live plays a important role in shaping the person's perception about the life. Ø Socializing allows you to share your ideas, believes, values and provides an equal opportunity to listen to what others have to say and have a positive attitude towards problems you may face in everyday life. Family/Friends Ø The support of family and friends is an essential part of maintaining your quality of life. Ø Family and friends provide you with emotional support, physical comfort, spiritual guidance, a welcome diversion and assistance. Ø Spending quality time with your friends and family will enrich your life. Share a meal, play a game, or look through an old photograph album together. Ø Writing an ethical will - or your philosophy of life - is another way to share important beliefs with your family. Support group Ø Support groups provide patients with an opportunity to see the problems they are confronting through the eyes of others. This can give patients a new perspective on their situation, reduce the inappropriate guilt felt by some, and help patients to recognize that their problems are the result of the cancer, rather than some personal failing. Questions such as "Why me?" take on a new meaning in a group of people wondering the same thing. 16
  • 19. Spiritual Aspect Ø Being spiritual helps in more than one way. It is good to keep your faith on supreme being whom you trust. Ø Trust on spiritual being channels your energy to your creator. No matter what is your religion, faith in your creator can bring you peace, good health and all other blessing. Spirituality, Faith and Religion Ø At times of extreme vulnerability, we all tend to pay more attention to our innate spirituality and seek to restore a feeling of being connected with the universe or a spiritual idea beyond ourselves. Ø We may seek this liaison through prayer and a renewed devotion to God. In the event of treatment failure and progressive disease, spirituality can help ease the pain of separation from loved ones and the things of this world. Ø Spirituality also plays a role in end-of-life care, helping patients utilize their remaining time to achieve a sense of peace and purpose, even in their final weeks, days or hours. Spiritual practices can strengthen feelings of hope or give meaning to life prior to death Some religion's way to increase one's feeling of being in control ™ Collaborative religious coping- Seeking control in solving problems through a partnership with God. ™ Active religious surrender- Turning control over to God after all else has failed. ™ Pleading for direct intercession- Seeking control indirectly by praying for a miracle or divine intercession ™ Passive religious deferral- Waiting for God to control the situation ™ Self-directing religious coping- Believing that God gives 17 individuals the tools and resources to solve problems
  • 20. Leaving instructions to loved ones Ø Therefore, this is the time to leave clear instructions as to whether you want to be resuscitated or treated, if you have no chance of regaining a reasonable quality of life. Ø You will also want to leave written instructions for your family and friends, if death occurs, telling them how you want your remains handled and type of funeral service. Ø If you don't have a will for the disposition of your estate, this is a good time to get that out of the way as well. You can always change it later. The act of leaving instructions on these matters is a gift to those you love. Conclusion Ø Health professionals today believe that a combination of medical therapy and supportive care offers the best chance to maintain a patient's quality of life. Ø Satisfaction of these diverse needs demonstrates the powerful connection between mind and body and improves quality of life. Ø Cancer - because it can have an impact on every aspect of your life, from your faith and the quality of your relationships to your physical being and your career is an assault on your life. Yet, as we have seen with so many of our patients, it need not destroy the quality of your life. 18
  • 21. Steps for Improving Your Quality of Life F Conserve your energy for essential or pleasurable activities. F Work collaboratively with your medical team so that you can get the best possible medical and supportive care. F Set realistic, achievable goals. F Don't let mistakes debilitate or destroy you. Move on. F Avoid negative thinking and self-destructive behavior. F Make end-of-life decisions, including writing legal and medical wills, and an Advanced Directive. F Take control. Even when your prognosis is not good, you still have choices. F Try to maintain your hope, endurance, faith, and courage. Seek spiritual guidance from your faith, community, religious or inspirational readings, or other sources. F Acknowledge your need for psychological support and seek assistance from a professional counselor, pastor, social worker, or a wise friend or family member. F Learn new techniques to promote relaxation, such as yoga and meditation. F Engage in pleasurable diversions, such as art, music, hobbies, social events and physical activities. F Give of yourself to others. F Strengthen your relationships by spending more quality time with family members and friends. F Recognize the sources of your anger and use techniques of forgiveness and mindful meditation to move on. F Try not to let your illness dominate your life. Be willing to make the necessary compromises as you go through treatment. Assignment 1. Cancer is the abnormal and uncontrolled __________ of cancer cells. 2. Surgery removes___________tissues from the body. 3. _________is the use of high-engergy rays to kill cancer cells. 4. Cancer diagnosis and treatment diminishes the_________ of life. 5.Quality of life can be categorized into_______,_______,_______&______ aspects 19